|April 11, 2012|
April is Testicular Cancer Awareness Month and the American Cancer Society estimates that about 8,600 cases will be diagnosed in the United States in 2012.
Testicular cancer is not common; it accounts for only 1 percent of cancers in men and a man's lifetime chance of developing the disease is about 1 in 270. Still, rates of occurrence have been increasing and according to the National Cancer Institute, testicular cancer is the most common form of cancer in men between 15 and 34 years of age.
Treatment is so successful that the risk of dying from this cancer is very low about 1 in 5,000 but successful treatment is dependent on early diagnosis.
"Testicular cancer is one of the most treatable and curable forms of cancer when it is caught early," said Dr. Joon Yim, director of Genitourinary Pathology at Acupath Laboratories Inc., an anatomic pathology and cancer genetics laboratory in Plainview, N.Y. "The danger is that the disease can go undetected in its early stages because men don't know what to look for or because they disregard signs and symptoms. Testicular Cancer Awareness Month gives us the opportunity to help men understand how the disease is diagnosed and ensure that we catch it early."
Common symptoms of testicular cancer include swelling and/or a lump in one or both testes, with or without pain; a feeling of heaviness in the scrotum; and a dull feeling of pain in the lower abdomen, groin, or lower back. While these symptoms may be caused by other conditions, they should be evaluated by a physician. If cancer is suspected, the doctor will order both laboratory tests and non-lab tests, such as ultrasound.
According to Yim, "While there is no blood test that can definitively detect testicular cancer, tests for tumor markers in the blood are useful in establishing a diagnosis and are also used to monitor the effectiveness of treatment and detect recurrences of testicular cancer."
Tumor markers are substances that appear in the bloodstream when cancer is present. Tumor markers such as AFP (alpha-fetoprotein) and hCG (human chorionic gonadotropin) may be elevated in cases of testicular cancer. AFP is almost always elevated in nonseminomatous tumors, while hCG may be elevated in both seminomas and nonseminomas. These two types of testicular cancer develop in the germ cells that produce sperm and account for more than 90 percent of testicular cancers.
LDH (lactate dehydrogenase), an enzyme found in many body tissues, is released into the bloodstream when cellular damage occurs. LDH is not specific for testicular cancer but can provide additional information that is useful in staging and risk assessment.
If blood tests show elevated levels of tumor markers and if ultrasound confirms the presence of a mass in the testicle, the usual procedure is to remove the entire testicle and have a pathologist examine the tissue microscopically. If cancer cells are present, the pathologist will determine the type through the use of immunohistochemical and other stains and aid in the staging of the cancer, also determining if it has spread to other organs. Genetic testing may also be performed.
"There is no known cause of testicular cancer but hereditary factors do play a role. Brothers and sons of men with testicular cancer are at significantly greater risk of developing the disease," Yim said.
Researchers have recently found the first evidence of specific genetic variations, on chromosomes 5, 6 and 12, that increase the risk of developing testicular germ cell tumors. Genetic testing may be used in screening men with a family history of the disease and in the definitive diagnosis of tumors. Men of European descent are at greater risk for testicular cancer than are those of African, Hispanic or Asian heritage.
Other risk factors include undescended testicles, abnormal development of the testes, Klinefelter syndrome (a sex chromosome disorder), and a family or personal history of testicular cancer. Those individuals who handle pesticides, leather workers, miners, oil well workers, and HIV-positive men also appear to be at higher risk.
"Testicular cancer is one of the most curable forms of cancer, with a cure rate in excess of 90 percent but most types can spread if left unchecked, invading and damaging the other testicle, and metastasizing to the lymph nodes or other body organs, such as the lungs," Yim said. "Early detection and treatment is crucial to a favorable outcome. That's why Testicular Cancer Awareness Month is so important. It brings attention to the issue and helps men understand how to identify the warning signs."
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